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Association of age of initiation and type of complementary foods with body mass index and weight-for-length at 12 months of age in preterm infants

Journal of Perinatology volume 40, pages 1394–1404 (2020)Cite this article

Subjects

Abstract

Objective

To assess whether in very preterm infants (1) body mass index (BMI) Z-score and weight-for-length (WtFL) Z-score at 1 year of age and (2) head growth from discharge to 1 year are associated with breastfeeding at discharge and the age of onset and type of complementary foods.

Study design

Observational cohort study.

Results

Infants started on only ready-made complementary (RMC) feedings at ≤26 weeks adjusted age had the highest adjusted BMI Z-score and WtFL Z-score at 1 year of age. Adjusted change in fronto-occipital circumference was highest in infants either discharged on breastmilk or receiving home-made complementary food with/without RMC (HMM) at ≤26 weeks adjusted age.

Conclusions

Infants started on RMC ≤26 weeks adjusted age had the highest BMI Z-score and WtFL Z-score at 1 year. Head growth from discharge to 1 year was highest in infants either discharged on breastmilk or receiving HMM at ≤26 weeks adjusted age.

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Fig. 1: Serial values of body mass index (BMI) Z-score and weight-for-length (WtFL) Z-score from discharge to 1-year postnatal age versus type and adjusted age at initiation of complementary food at Epoch 1 and Epoch 2.

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Acknowledgements

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Susan Chacko, RN, and Maria DeLeon, RN, were research coordinators for part of this study. Chen Du, RD, Elizabeth Brammer, RD, Audrey Edwards, RD, and Theresa Jacob, RD, dietitians at Parkland Hospital, obtained anthropometric measurements for this study and participated in patient recruitment, assessments of growth and laboratory results and recommendations for nutritional interventions. Elen Petrosyan, RD, dietitian at Parkland Hospital, helped in organizing the logistics of patient recruitment, measurements, and research planning. Sandra Gosser, NNP, helped with education of nurse practitioners and coordination of care with the dietitians and the physicians. Timothy Brannon, MD, helped with changes on EPIC, specifically with implementation of parameters to define AGA at birth. Rebecca Thomas, RN and Catherine Vanbeek, RN, NP, helped with changes in EPIC ordering and education of nurses. Erin McDougald, PNP, Anna Puentez, PNP, Jillian Waterbury, PNP, Linda Madden, PNP, Sally Adams, PNP, Renea Powell, NNP, Jerithea Tidwell, PNP, Karen Malouf, RD, Shannon Despino, RD, Carly Brenner, RD, Marianna Skertchy, RD, Lizette Torres, RN, and Alicia Guzman helped with collection of follow-up data. Anne-Marie Rosenfeld, RN, helped with analysis and interpretation of the data. Some of the patients included in the QI described in the current paper were enrolled in a blinded randomized trial: Clinicaltrials.gov NCT02372136. The study sponsors had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review and approval of the paper; and decision to submit the paper for publication.

Funding

This study was funded by the George L. MacGregor Professorship (CR Rosenfeld) and Children’s Medical Center Clinical Advisory Committee (CCRAC)—Senior Investigator Research Award—New Direction (LP Brion).

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Luc P. Brion, Charles R. Rosenfeld, Roy Heyne, Patti J. Burchfield & Maria Caraig

  2. Parkland Health and Hospital System, Dallas, TX, USA

    L. Steven Brown & Cheryl S. Lair

  3. Childrens’ Medical Center, Dallas, TX, USA

    Elizabeth Heyne

  4. Wake Forest Baptist Health, Winston-Salem, NC, USA

    Emily L. Dohoney

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  1. Luc P. Brion
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Contributions

LPB wrote the first draft of the paper. He conceptualized and designed the study. He extracted data from medical records at the Thrive clinic, participated in the interpretation of the data, conducted statistical analyses, critically reviewed the revisions, and approved the final paper as submitted. CRR and RH conceptualized and designed the study. They participated in the interpretation of the data, critically reviewed the revisions, and approved the final paper as submitted. LSB conceptualized and designed the study. He conducted statistical analyses, participated in the interpretation of the data, critically reviewed the revisions, and approved the final paper as submitted. CSL conceptualized and designed nutritional guidelines for the NICU and discharge, anthropometric data, and data extraction from EPIC. She obtained anthropometric measurements for the QI and participated in assessments of growth and laboratory results and recommendations for nutritional interventions. She participated in the interpretation of the data, critically reviewed the revisions, and approved the final paper as submitted. ELD conceptualized and designed nutritional guidelines at and after discharge. ELD and EH standardized the interviews and data entry into outpatient electronic medical records, critically reviewed the revisions, and approved the final paper as submitted. PJB collected and entered the data into the databases. She participated in the interpretation of the data, critically reviewed the paper, and approved the final paper as submitted. MC was research coordinator for a large part of this study. She measured patients in the NICU and at follow-up. She extracted data from medical records into databases, critically reviewed the paper and approved the final paper as submitted.

Corresponding author

Correspondence to Luc P. Brion.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the IRB of the University of Texas Southwestern Medical Center, Parkland Hospital and Health Systems and Children’s Medical Center.

Informed consent

Informed consent was waived for all data included in this study.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Preliminary results were submitted as abstract for presentation at PAS, Philadelphia, PA, May 2–5, 2020: Brion LP, Rosenfeld CR, Heyne R, Brown LS, Lair C, Heyne E, Dohoney E, Burchfield PJ, Caraig M. Association between age of initiation and type of complementary foods with body mass index (BMI) at 1 year of age in appropriate for gestational age (GA) 23–28 week-GA infants.

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Brion, L.P., Rosenfeld, C.R., Heyne, R. et al. Association of age of initiation and type of complementary foods with body mass index and weight-for-length at 12 months of age in preterm infants. J Perinatol 40, 1394–1404 (2020). https://doi.org/10.1038/s41372-020-0637-x

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